Mosher Christopher L, Osazuwa-Peters Oyomoare L, Nanna Michael G, MacIntyre Neil R, Que Loretta G, Palmer Scott M, Jones W Schuyler, O'Brien Emily C
Division of Pulmonary, Allergy, and Critical Care Medicine Duke University School of Medicine Durham NC USA.
Duke Clinical Research Institute Durham NC USA.
J Am Heart Assoc. 2025 Jan 21;14(2):e035010. doi: 10.1161/JAHA.124.035010. Epub 2025 Jan 10.
Meta-analyses have suggested that the risk of cardiovascular disease events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation, but the populations at highest risk have not been well characterized to date.
The authors analyzed the risk of atherosclerotic cardiovascular disease (ASCVD) hospitalizations after COPD hospitalization compared with before COPD hospitalization and patient factors associated with ASCVD hospitalizations after COPD hospitalization among 2 high-risk patient cohorts. The primary outcome was risk of an ASCVD hospitalization composite outcome (myocardial infarction, coronary artery bypass graft, percutaneous coronary intervention, stroke, transient ischemic accident) after COPD hospitalization relative to before COPD hospitalization. Additional analyses evaluated for risk factors associated with the composite ASCVD hospitalization outcome. In the high-risk primary prevention cohort, the hazard ratio (HR) estimate following adjustment for the composite ASCVD hospitalization outcome after COPD hospitalization versus before COPD hospitalization for 30 days was 0.74 (95% CI, 0.66-0.82; ≤0.0001); for 90 days, 0.69 (95% CI, 0.64-0.75; ≤0.0001); and for 1 year, 0.78 (95% CI, 0.73-0.82; ≤0.0001). In the secondary prevention cohort, the HR for 30-day hospitalization was 1.15 (95% CI, 1.05-1.26; =0.0036); 90-day hospitalization, 1.08 (95% CI, 1.01-1.15; =0.0178); and 1-year hospitalization, 1.07 (95% CI, 1.02-1.11; =0.0026). Among the 19 characteristics evaluated, hyperlipidemia and history of acute ASCVD event were associated with the highest risk of ASCVD events 1 year after COPD hospitalization in the high-risk primary and secondary prevention cohorts.
The risk of ASCVD hospitalization was higher in patients with established ASCVD and lower among high-risk patients without established ASCVD after-COPD hospitalization relative to before hospitalization. We identified multiple risk factors for ASCVD hospitalization after COPD hospitalization.
荟萃分析表明，慢性阻塞性肺疾病（COPD）急性加重后心血管疾病事件的风险显著更高，但迄今为止，最高风险人群尚未得到很好的界定。
作者分析了2个高危患者队列中COPD住院后与住院前相比动脉粥样硬化性心血管疾病（ASCVD）住院的风险，以及COPD住院后与ASCVD住院相关的患者因素。主要结局是COPD住院后相对于住院前ASCVD住院复合结局（心肌梗死、冠状动脉搭桥术、经皮冠状动脉介入治疗、中风、短暂性脑缺血发作）的风险。额外的分析评估了与复合ASCVD住院结局相关的危险因素。在高危一级预防队列中，调整后COPD住院后30天、90天和1年的复合ASCVD住院结局相对于住院前的风险比（HR）估计值分别为0.74（95%CI，0.66 - 0.82；P≤0.0001）、0.69（95%CI，0.64 - 0.75；P≤0.0001）和0.78（95%CI，0.73 - 0.82；P≤0.0001）。在二级预防队列中，30天住院的HR为1.15（95%CI，1.05 - 1.26；P = 0.0036）；90天住院的HR为1.08（95%CI，1.01 - 1.15；P = 0.0178）；1年住院的HR为1.07（95%CI，1.02 - 1.11；P = 0.0026）。在评估的19项特征中，高脂血症和急性ASCVD事件史与高危一级和二级预防队列中COPD住院1年后ASCVD事件的最高风险相关。
已确诊ASCVD的患者ASCVD住院风险较高，而无确诊ASCVD的高危患者在COPD住院后相对于住院前的风险较低。我们确定了COPD住院后ASCVD住院的多个危险因素。
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